Provider Demographics
NPI:1023309515
Name:PAYSON, ELEANOR D (LMSW, ACSW, LMFT)
Entity type:Individual
Prefix:MS
First Name:ELEANOR
Middle Name:D
Last Name:PAYSON
Suffix:
Gender:F
Credentials:LMSW, ACSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 W 7TH ST
Mailing Address - Street 2:SUITE 290
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2513
Mailing Address - Country:US
Mailing Address - Phone:248-548-0306
Mailing Address - Fax:248-541-4379
Practice Address - Street 1:333 W 7TH ST
Practice Address - Street 2:SUITE 290
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2513
Practice Address - Country:US
Practice Address - Phone:248-548-0306
Practice Address - Fax:248-541-4379
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010463621041C0700X
MI4101005574106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist